Australasian Anaesthesia 2011 - Australian and New Zealand ...

More documents

Recommendations

Info

76 Australasian Anaesthesia 201177REFERENCES1. Eckenhoff JE. Some anatomic considerations of the infant larynx influencing endotracheal anesthesia.Anesthesiology 1951;12(4):401-410.2. McDonald IH, Stocks JG. Prolonged nasotracheal intubation. BJA 1965;37:161-173.3. Allen TH, Steven IM. Prolonged endotracheal intubation in infants and children. BMJ 1965; 37:566-573.4. Holzki J. Laryngeal damage from tracheal intubation. Paediatric Anaesthesia 1997;7:435-437.5. Flynn PE, Black AE, Mitchell V. The use of cuffed tracheal tubes for paediatric tracheal intubation, a survey ofspecialist practice in the United Kingdom. European Journal of Anaesthesiolgy 2008;25:685-688.6. Deakers TW, Reynolds G, Stretton M, Newth CJL. Cuffed endotracheal tubes in pediatric intensive care.The Journal of Pediatrics 1994;125(1):57-62.7. Khine HH, Corddry DH, Kettrick RG et-al. Comparison of Cuffed and Uncuffed Endotracheal Tubes in YoungChildren during General Anesthesia. Anesthesiology 1997;86:627-631.8. Murat I. Cuffed tubes in children: a 3 year experience in a single institution (Letter). Paediatric Anaesthesia2001;11:748-749.9. Newth CJ, Rachman B, Patel N, Hammer J. The use of cuffed versus uncuffed endotracheal tubes in pediatricintensive care. The Journal of Pediatrics 2004;144:333-337.10. Holzki J. Stridor is not a scientifically valid outcome measure for assessing airway injury. Pediatric Anesthesia2009;19(Supp.1):180-197.11. James I. Cuffed tubes in children. Paediatric Anaesthesia. 2001;11:259-263.12. Mahmoud RA, Proquitte H, Fawzy N, et-al. Tracheal tube airleak in clinical practice and impact on tidal volumemeasurement in ventilated neonates. Neonatal Intensive Care 2011;12(2):197-202.13. Suominen P, Taivainen T, Tuominen N, et-al. Optimally fitted tracheal tubes decrease the probability ofpostextubation adverse events in children undergoing general anesthesia. Pediatric Anesthesia 2006;16:641-647.14. Felton M, Schmautz E, Delaporte-Cerceau S, et-al. Endotracheal Tube Cuff Pressure Is Unpredictable In Children.Anesth Analg 2003;97:1612-1616.15. Weiss M, Dullenkopf A, Gysin C, et-al. Shortcomings of cuffed paediatric tracheal tubes. BJA 2004;92(1):78-88.16. Weiss M, Dullenkopf A, Fischer JE, et-al. Prospective randomised controlled mutli-centre trial of cuffed oruncuffed endotracheal tubes in small children. BJA 2009;103(6):867-873.17. Lonnqvist PA. Cuffed or uncuffed tracheal tubes during anaesthesia in infants and small children: time to putthe eternal discussion to rest? BJA 2009;103(6):783-785.18. Duracher C, Schmautz E, Martinon C, et-al. Evaluation of cuffed tracheal tube size predicted using the Khineformula in children. Pediatric Anesthesia 2008;18:113-118.
Jet Ventilation and Anaesthesia 79Jet Ventilation and AnaesthesiaA practical guide to understanding jet ventilation and its currentapplications in clinical anaesthetic practiceSASANKA S DHARA, FANZCA, VISITING MEDICAL OFFICER, DEPARTMENT OF ANAESTHESIA, ROYALHOBART HOSPITAL.Dr Dhara is a part time VMO Anaesthetist at the Royal Hobart Hospital. His career includes a long period as Directorof the Anaesthetic Department at Singapore General Hospital. Over his career he has pursued numerous interestsbut especially in the field of difficult airway management and particularly in anaesthesia for head and neck surgery.He has numerous publications in these areas, including the application of high frequency jet ventilation.INTRODUCTIONJet ventilation refers to the form of mechanical ventilation in which the inspiratory gas is delivered into the tracheaat high pressure (101– 405kPa) through a conduit of small diameter. In low frequency (< 1 Hz) mode it is mostlyused for emergency oxygenation (such as in “can’t intubate can’t ventilate” scenarios) but with higher frequency(1–10 Hz) it has numerous applications in anaesthesia and intensive care. This review summarises the physiology,mechanics and practicalities of using jet ventilation, both low and high frequency and then looks at its applicationin a range of clinical anaesthetic settings. This review does not cover the use of High Frequency Jet Ventilation(HFJV) in intensive care.HISTORYThe history of insufflating gases through tracheal cannulae to sustain life goes back several centuries. 1 However,most of our current understanding of the mechanical and physiological aspects of jet ventilation and its applicationsin anaesthesia and intensive care practice has developed through the 1970s and 80s. The most important pioneeringarticles [2-10] are summarised in table 1.Table 1. Landmark publications on transtracheal oxygenation and jet ventilation 2-10Jacoby 1951Jacoby 1956Sanders 1967Spoerel 1971Oultol 1971Jacobs 1972Smith 1973 & 1975Klain & Smith 1977Percutaneous, transtracheal, apnoeic oxygenation with 4-5L/min of oxygen.Use of the above technique for oxygenation in patients with airway obstruction.Jet ventilation at 344 kpa (50 psi) through a rigid bronchoscope providing unhinderedEarliest description of elective, percutaneous, trans tracheal jet ventilation (PTTJV) duringanaesthesia.Description of a dedicated jet channel in a Jako laryngoscope for ventilation duringlaryngoscopic procedures.Intermittent insufflation with a pressure of 413kpa (60psi) for resuscitation.Report of a series of patients undergoing PTTJV during elective surgery as wellDevelopment of a fluid logic based jet ventilator capable of 60-100 breaths per minute.MECHANISM OF ACTION OF HFJVHFJV is unusual in that it can produce adequate respiratory gas exchange even when the apparent tidal volume isa fraction of the anatomical dead space. It is thought that there are several mechanisms involved in driving gasexchange during high frequency jet ventilation, each at different levels of the respiratory anatomy having differentflow profiles and resistance characteristics. 11-12Within the trachea and large airwaysThere is direct ventilation of alveoli close to main bronchi in the normal manner by convection or “bulk flow”. Thehigh velocity stream of inspiratory flow occurring with a jet creates additional flow from entrainment in the presenceof a patent proximal airway. In low frequency jet ventilation, this entrainment will form a significant part of the tidalvolume. Together, the high velocity stream and entrainment cause turbulence and this leads to enhanced gas mixing.
Page 3: ContentsPublished in 2012 by:Austra
Page 8 and 9: 4 Australasian Anaesthesia 2011 5Ta
Page 11 and 12: Management of opioid side effects -
Page 13 and 14: 14 Australasian Anaesthesia 2011Man
Page 16 and 17: 20 Australasian Anaesthesia 2011Pet
Page 18: 24 Australasian Anaesthesia 2011Pet
Page 23 and 24: 34 Australasian Anaesthesia 2011The
Page 28 and 29: 44 Australasian Anaesthesia 2011Ana
Page 31 and 32: 50 Australasian Anaesthesia 2011Ana
Page 33: 54 Australasian Anaesthesia 2011Ana
Page 36 and 37: 60 Australasian Anaesthesia 2011Rea
Page 38: 64 Australasian Anaesthesia 2011Rea
Page 41 and 42: 70 Australasian Anaesthesia 2011Cri
Page 43: 74 Australasian Anaesthesia 2011Tre
Page 47 and 48: 82 Australasian Anaesthesia 2011Jet
Page 49 and 50: 86 Australasian Anaesthesia 2011Jet
Page 52 and 53: Care of the potential lung transpla
Page 54 and 55: 96 Australasian Anaesthesia 2011Car
Page 56 and 57: 100 Australasian Anaesthesia 2011Ca
Page 59 and 60: 106 Australasian Anaesthesia 2011 T
Page 61 and 62: 110 Australasian Anaesthesia 2011Th
Page 63 and 64: Smoking and surgery: time to clear
Page 65 and 66: 118 Australasian Anaesthesia 2011Sm
Page 67 and 68: 122 Australasian Anaesthesia 2011Sm
Page 73 and 74: Intravenous Iron in Surgery and Obs
Page 75 and 76: 138 Australasian Anaesthesia 2011In
Page 77 and 78: 142 Australasian Anaesthesia 201114
Page 79 and 80: 146 Australasian Anaesthesia 2011Si
Page 81 and 82: Sickle Cell Disease in Australia -
Page 83 and 84: 154 Australasian Anaesthesia 2011Si
Page 85 and 86: 158 Australasian Anaesthesia 2011wa
Page 87 and 88: Heart Disease in Pregnancy and Labo
Page 89 and 90: 166 Australasian Anaesthesia 2011He
Page 91 and 92: Perioperative Transthoracic Echocar
Page 93 and 94: 174 Australasian Anaesthesia 2011Pe
Page 95 and 96:
Cardiac output monitoring in non-ca
Page 97 and 98:
Cardiac output monitoring in non-ca
Page 99 and 100:
186 Australasian Anaesthesia 2011Ca
Page 101 and 102:
190 Australasian Anaesthesia 2011Te
Page 103 and 104:
194 Australasian Anaesthesia 201119
Page 105 and 106:
198 Australasian Anaesthesia 2011In
Page 107 and 108:
What next for anaesthesia in Austra
Page 110 and 111:
Leadership in Anaesthetic Departmen
Page 112:
212 Australasian Anaesthesia 2011Th
show all

Australasian Anaesthesia 2011 - Australian and New Zealand ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?